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Varicose Veins

Topic Overview

What are varicose veins?

Varicose veins are
twisted, enlarged veins near the surface of the skin. They are most common in
the legs and ankles. They usually aren't serious, but they can sometimes lead
to other problems.

What causes varicose veins?

Varicose veins are
caused by weakened valves and veins in your legs. Normally, one-way valves in
your veins keep blood flowing from your legs up toward your heart. When these
valves do not work as they should, blood collects in your legs, and pressure
builds up. The veins become weak, large, and twisted.

Varicose
veins often run in families. Aging also increases your risk.

Being
overweight or pregnant or having a job where you must stand for long periods of
time increases pressure on leg veins. This can lead to varicose veins.

What are the symptoms?

Varicose veins look dark
blue, swollen, and twisted under the skin. Some people do not have any
symptoms. Mild symptoms may include:

Heaviness, burning, aching, tiredness, or
pain in your legs. Symptoms may be worse after you stand or sit for long
periods of time.

Swelling in your feet and
ankles.

Itching over the vein.

More serious symptoms include:

Leg swelling.

Swelling and calf
pain after you sit or stand for long periods of time.

Skin changes,
such as:

Color changes.

Dry, thinned
skin.

Inflammation.

Scaling.

Open sores, or you may bleed after a minor
injury.

Varicose veins are common and usually aren't a sign of a
serious problem. But in some cases, varicose veins can be a sign of a blockage
in the deeper veins called
deep vein thrombosis. If you have this problem, you
may need treatment for it.

How are varicose veins diagnosed?

Your doctor will
look at your legs and feet. Varicose veins are easy to see, especially when you
stand up. Your doctor will check your legs for tender areas, swelling, skin
color changes, sores, and other signs of skin breakdown.

You might need further tests if you plan to have treatment or if you
have signs of a deep vein problem.

How are they treated?

Home treatment may be all
you need to ease your symptoms and keep the varicose veins from getting worse.
You can:

Wear compression stockings.

Prop up (elevate) your legs.

Avoid
long periods of sitting or standing.

Get plenty of exercise.

If you need treatment or you are concerned about how the
veins look, your options may include:

Superficial
thrombophlebitis (when a blood clot and inflammation
develop in a small vein near the surface of the skin).

Open sores
(ulcerations).

Bleeding and/or bruising after a minor
injury.

Symptoms of varicose veins may become more severe a few
days before and during a woman's menstrual period.

What Happens

Most
varicose veins aren't a serious medical problem, but
they sometimes can lead to complications.

Complications can
include:

Bleeding from a varicose vein, which may occur
without an injury or after an injury to the thin skin over the varicose vein.
Bleeding can be heavy, but it can be controlled by elevating the leg and
applying pressure to the area that is bleeding.

Blood clots or
inflammation (superficial
thrombophlebitis), when a blood clot and inflammation
develop in a small vein near the surface of the skin. Unlike blood clots in
deep veins, clots in superficial veins rarely travel to the heart or lungs,
where they could cause serious blockages.

Fungal and
bacterial infections, which may arise from skin problems resulting from fluid
buildup (edema) in the leg and increased risk of tissue
infection (cellulitis).

Varicose veins most often are a result of problems in the
superficial veins just under the skin. But they can happen along with problems
or disease in the
deep veins and
perforating veins, which connect the deep and the
superficial veins. Complications are much more common when varicose veins are caused by
or linked with these deeper veins.

What Increases Your Risk

Being overweight (tends to be a
stronger factor in women). Having low muscle mass and high body fat decreases
the support for the veins.

Family history of varicose
veins.

Prolonged sitting or standing.

Conditions that
increase pressure in the abdomen, such as liver disease, fluid in the abdomen,
previous groin surgery, or
heart failure.

Injury to the
veins.

Blood clots.

When To Call a Doctor

Call your doctor if you have
varicose veins and:

Your leg suddenly becomes swollen and painful.
You might have a blood clot in a deep vein, which can be serious and may need
prompt attention.

Skin over a varicose vein begins to bleed on its
own or when it is injured. The skin over varicose veins is often thin and can
bleed heavily. If this happens, elevate your leg and apply pressure directly to
the vein to stop the bleeding.

Your leg has a tender lump. This
could be a clot or inflammation in a vein just under the skin, which is usually
not dangerous but may need treatment.

You develop an open sore
(ulcer).

Your varicose vein symptoms don't improve with home treatment, or
there are symptoms you are concerned about.

Watchful waiting

Varicose veins are common and are generally not
a serious health problem. With a doctor keeping an eye on the condition, most
people can manage varicose veins with home treatment, such as exercising,
wearing compression stockings, and elevating the legs.

Exams and Tests

The most important tools in
diagnosing
varicose veins are the
physical examination and medical history. Varicose
veins are typically diagnosed based on their appearance, and no other special
tests are needed to confirm the diagnosis.

The medical history will include questions about
any vein problems, serious leg injuries, or leg ulcers you have had in the
past, as well as any other risk factors you might have, including whether your
family has a history of varicose veins. Talk to your doctor about any symptoms
you are having (such as swelling, fatigue, or cramps in your legs) and what you
have been doing to treat your symptoms, if anything.

During the
physical exam, the doctor will examine your legs and feet (or any other
affected areas) for varicose veins. You will likely stand during this test. Varicose veins are usually easy to see. The doctor
will also check your legs for tender areas, swelling, skin color changes,
ulcers, and other signs of skin breakdown. To study the blood flow in your
legs, the doctor may ask you to move your legs around in different
positions.

If a problem with the
deep veins or complications are suspected based on your symptoms and exam,
other tests may be done.

Duplex Doppler ultrasound is the most
commonly used noninvasive test that can help your doctor study blood flow in
your leg veins.

An ultrasound might be done if you are considering having a procedure to treat varicose veins.

Treatment Overview

The goals of
varicose vein treatment are to reduce symptoms and
prevent complications. For some, the goal may be improved appearance. Home
treatment—such as
exercising and wearing compression stockings—is typically the first approach.

If home treatment does not help, there are procedures or a surgery that can treat varicose veins. These include:

Laser treatment. Laser energy is used to scar and
destroy varicose veins. This is called ablation.

Simple laser therapy is done on small veins close to the skin, such as spider veins. The laser is used outside of your skin.

Ligation and stripping. Incisions are made over the
varicose veins, and the vein is tied off (ligated) and removed
(stripped).

Phlebectomy. Several tiny
cuts are made in the skin through which the varicose vein is removed.

Radiofrequency treatment. Radiofrequency energy
(instead of laser energy) is used inside a vein to scar and close it off. It
can be used to close off a large varicose vein in the leg.

Sclerotherapy. A chemical (sclerosant)
is injected into a varicose vein to damage and scar the inside lining of the
vein, causing the vein to close. This usually works best for small
veins.

Treatment may be needed to remove the damaged veins,
treat complications, or correct an underlying problem that is causing the
varicose veins. The size of your varicose veins affects your treatment options.
Generally, larger varicose veins are treated with ligation and
stripping, laser treatment, or radiofrequency treatment. In some cases, a
combination of treatments may work best. Smaller varicose veins and
spider veins are usually treated with sclerotherapy or
laser therapy on your skin.

Some people may want to improve how
their legs look, even though their varicose veins are not causing other
problems. In these cases, a procedure or surgery may be appropriate—as long as there are no other health problems that
make these treatments risky.

What to think about

If you are thinking about having a vein
treatment, you may want to know which treatment is best for you. No single
approach is best for treating all varicose veins. Talk to your doctor about your
choices.

If you are considering a surgery or procedure, consider some
questions about treatment. These questions might
include: How much experience does the doctor have with the particular
treatment? How much do the exam and treatment cost?

All treatment methods—including all types of surgery,
sclerotherapy, laser, and radiofrequency ablation—can scar or discolor the
skin.

Treatment can be more difficult for deep veins that are damaged or for perforating veins, which connect the deep and
superficial veins. These veins may be treated with surgery, radiofrequency ablation, or sclerotherapy, or a combination of these treatments.

Prevention

Self-care. This includes exercising and avoiding long periods of standing or sitting.

Home Treatment

Home treatment is recommended for most
people with
varicose veins that aren't causing more serious
problems. Home treatment can relieve symptoms, slow down the progress of
varicose veins, and prevent complications such as sores or
bleeding. For many people with varicose veins, home treatment is the only
treatment they need.

These measures may help you avoid surgery or other medical
treatment for your varicose veins. But you may still want surgery or a procedure if you are
not satisfied with their appearance or your symptoms are not well
controlled.

After an injury

Superficial varicose veins can sometimes cause minor
problems like bruising or bleeding if you scratch or cut the skin over a larger
vein. Small blood clots may occasionally form in the surface veins (superficial
phlebitis). Most of these problems can be safely treated at home.

If you bump your leg so hard that you know it
is likely to bruise, elevate your leg and apply ice or a cold pack as soon as
you can for the next hour or two. This may help reduce the amount of bleeding
under the skin and minimize bruising.

If you cut or scratch the
skin over a vein, it may bleed a lot. Elevate your leg and apply firm pressure
with a clean bandage over the site of the bleeding. Continue to apply pressure
for a full 15 minutes. Do not check to see if the bleeding has stopped sooner.
If the bleeding hasn't stopped after 15 minutes, apply pressure again for
another 15 minutes. You can repeat this up to three times for a total of 45
minutes.

Blood clot in a superficial vein (superficial
phlebitis)

Signs of a small blood clot in a superficial varicose vein
(superficial phlebitis) include tenderness and swelling over the vein. The vein
may feel firm. If your doctor has told you how to care for superficial
phlebitis, follow his or her instructions.

Often doctors will recommend that you elevate
your leg and apply heat with a warm, damp cloth or a heating pad set on low (to
prevent burns, put a towel or cloth between your leg and the heating
pad).

Your doctor may also tell you to take a
nonsteroidal anti-inflammatory drug (for example, two
aspirin or ibuprofen tablets taken 3 to 4 times a day at first and less often
as your symptoms go away). Be safe with medicines. Read and follow all instructions on the label.

Talk to your doctor if you are not sure
that your symptoms are caused by a superficial blood clot or if you are not
sure how to treat your symptoms.

Medications

Medicines are not generally used to treat
varicose veins.

Surgery

Surgery for varicose veins includes tying off (ligation) and removing (stripping) larger
veins. Surgery may be used to treat
varicose veins if:

The varicose veins have not responded to home
treatment and your symptoms are bothering you.

You are concerned
about the way varicose veins look, and laser treatment, radiofrequency
treatment, or
sclerotherapy is not likely to improve their
appearance to your satisfaction.

The size of your varicose veins affects your treatment options.
Typically, larger varicose veins are treated with ligation and
stripping, endovenous laser treatment, or radiofrequency treatment. For some people, a
combination of treatments may work best. Smaller varicose veins and
spider veins are usually treated with laser therapy on your skin or sclerotherapy.

What to think about

Some people may want to have surgery
to improve how their legs look, even though their varicose veins are not
causing other problems. Surgery may be appropriate in some cases as long as you
don't have other health problems that make the treatment risky.

Keep in mind that surgery for varicose veins done only for cosmetic reasons
(that is, not medically necessary) is usually not covered by insurance.

In some cases, a combination of surgery and
sclerotherapy may be used to treat varicose veins. Sclerotherapy is a
nonsurgical procedure in which a chemical is injected into the vein, causing
the vein to close off.

Other Treatment

There are several nonsurgical, minimally invasive
vein treatments for treating
varicose veins.

Sclerotherapy is a nonsurgical
procedure in which a chemical is injected into the vein, causing the vein to
close off.

What to think about

Some people may
want to have vein treatment to improve how their legs look, even though their
varicose veins are not causing other problems. Vein treatments may be
appropriate in some cases as long as you don't have other health problems that
make the treatment risky.

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NOTICE: This health information was not created by the University of Michigan Health System (UMHS) and may not necessarily reflect specific UMHS practices. For medical advice relating to your personal condition, please consult your doctor. Complete disclaimer